Primary Care Doctors Fail To Recognize Many Anxiety Disorders

Primary care providers fail to recognize anxiety disorders in two-thirds of patients with symptoms, reports a new study in General Hospital Psychiatry. “Anxiety is a very common condition in general practice. Patients with physical health problems and other mental disorders often have anxiety,” says the study’s lead author Anna Fernandez, Ph.D., a psychologist and researcher at the Parc Sanitari Sant Joan de Deu in Barcelona, Spain.

“People suffering from anxiety are often severely disabled by the condition. Since general practitioners are the gatekeepers of the healthcare system, it is very important that they recognize anxiety early on, so that patients can be referred or treated,” said Fernandez.

Fernandez and colleagues conducted a survey of 3,815 patients who had been seen at 77 primary care centers in Spain. Patients were interviewed by psychologists and assessed for anxiety disorders. Patients were also evaluated for disability, stress, social support, quality of life, and the presence of chronic physical conditions.

Overall, about 19 percent of patients met the criteria for an anxiety disorder in the previous 12 months, but general practitioners correctly recognized anxiety in only 28 to 32 percent of these patients.

“The most important finding of our paper is that general practitioners don’t differentiate between subtypes of anxiety disorders,” Fernandez says. While 253 patients had panic disorder — a type of anxiety characterized by panic “attacks” — general practitioners correctly identified none of them and misdiagnosed 3 others as having the condition. Conversely, they also misdiagnosed general anxiety disorder — a type of anxiety characterized by ongoing, daily anxiety — in 42 patients who did not have the disorder. General practitioners were more likely to accurately recognize anxiety in patients with high blood pressure and those whose main reason for the doctor’s visit was emotional problems.

Jaesu Han, M.D., a psychiatrist at the University of California, Davis, who works with primary care residents, says that failing to identify the specific type of anxiety disorder isn’t so important, since the initial treatment of most anxiety disorders is similar, involving medication and psychotherapy. “What’s more relevant is that general practitioners are able to recognize a clinically significant anxiety disorder,” Han says. Primary care doctors can quickly screen for anxiety using short patient questionnaires, he says.

Since the majority of patients with anxiety typically don’t act in bizarre or unusual ways, physicians may not always appreciate the impact anxiety has on patients’ lives, says Han. “When studies have followed people with anxiety over time, it’s been shown that anxiety is very burdensome,” Han says. “In the majority of cases, anxiety persists for many, many years. It is often a chronic condition that waxes and wanes, and can wreak havoc,” on a person’s ability to work and socialize.